Temporary Facial Paralysis Induced by Air Travel

Release: Immediate

Contact: Kenneth Satterfield561-447-5521 (May 9-14, 2002)703-519-1563[email protected]

Temporary Facial Paralysis Induced by Air Travel

Boca Raton, FL -- Changes in altitude and cabin pressurization during air travel can often cause ears to feel stuffy or achy, but for a select few, it may also cause temporary facial paralysis.

Alternobaric facial nerve palsy, or baroparesis, is a rapidly reversible facial palsy related to over-pressurization of the middle ear that usually appears during air flight ascent or while surfacing during scuba diving. This phenomenon occurs when pressure in the middle ear either from fluid build-up, solid particles, or both, compress the facial nerve and cause temporary paralysis. After descent or surfacing, ear pressure returns to normal and paralysis subsides.

Researchers Douglas D. Backous MD and Neil B. Hampson MD, both of The Listen for Life Center at Virginia Mason Center for Hyperbaric Medicine are presenting the findings of their case study, "Recurrent Facial Nerve Baroparesis with Airline Flight," May 10, 2002, at the Annual Meeting of the American Neurology Society http://itsa.ucsf.edu/~ajo/ANS/ANS.html being held at Boca Raton Resort & Club in Boca Raton, FL.

Methodology: A case study and literature review involving a 61 year-old male who suffered two consecutive incidents of alternobaric facial nerve palsy (baroparesis) on the left side of his face 90 minutes into flight was conducted. After undergoing an audiological and clinical examination, CT scanning of the temporal bones, and consultation with an allergist, the patient was found to have dense fluid in the middle ear collected in a mass near the facial nerve. The patient was initially treated in the physician's office with a tympanostomy (insertion of ventilation tube in the tympanic membrane). A surgical date was scheduled for a left mastoidectomy (surgical removal of mastoid cells) and tympanoplasty (plastic reconstruction of the bones of the middle ear).

Results: Surgical evaluation concluded the existence of dense secretions and solid particles in the middle ear; all were removed and a tympanoplasty was performed. Fungal and bacterial cultures grew no pathogens; gram stains and KOH prep test were negative. The patient, 20 months post-operative, has not experienced a recurrence of alternobaric facial palsy, despite multiple subsequent commercial air flights.

Conclusion: This is the fourth reported case of alternobaric facial nerve palsy associated with air flight and the only case with surgical intervention. It is likely that the combination of a middle ear containing solid secretions and vulnerable facial nerves with over-pressurization of the ear resulted in temporary facial palsy. After treatment, the patient did not experience further paralysis, despite continued air travel. Recognition of this benign form of facial palsy may avoid unnecessary re-pressurization treatments or flight restrictions.

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